Department of Pediatrics, University of Thessaly, Medical School, Biopolis, 411 10 Larissa, Greece.
BMC Infect Dis. 2010 Dec 13;10:351. doi: 10.1186/1471-2334-10-351.
In Greece, fusidic acid and clindamycin are commonly used for the empiric therapy of suspected staphylococcal infections.
The medical records of children examined at the outpatient clinics or admitted to the pediatric wards of the University General Hospital of Larissa, Central Greece, with community-associated staphylococcal infections from January 2003 to December 2009 were reviewed.
Of 309 children (0-14 years old), 21 (6.8%) had invasive infections and 288 (93.2%) skin and soft tissue infections (SSTIs). Thirty-five patients were ≤30 days of age. The proportion of staphylococcal infections caused by a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolate increased from 51.5% (69 of 134) in 2003-2006 to 63.4% (111 of 175) in 2007-2009 (P = 0.037). Among the CA-MRSA isolates, 88.9% were resistant to fusidic acid, 77.6% to tetracycline, and 21.1% to clindamycin. Clindamycin resistance increased from 0% (2003) to 31.2% (2009) among the CA-MRSA isolates (P = 0.011). Over the 7-year period, an increase in multidrug-resistant CA-MRSA isolates was observed (P = 0.004). One hundred and thirty-one (93.6%) of the 140 tested MRSA isolates were Panton-Valentine leukocidin-positive. Multilocus sequence typing of 72 CA-MRSA isolates revealed that they belonged to ST80 (n = 61), ST30 (n = 6), ST377 (n = 3), ST22 (n = 1), and ST152 (n = 1). Resistance to fusidic acid was observed in ST80 (58/61), ST30 (1/6), and ST22 (1/1) isolates.
In areas with high rate of infections caused by multidrug-resistant CA-MRSA isolates, predominantly belonging to the European ST80 clone, fusidic acid and clindamycin should be used cautiously as empiric therapy in patients with suspected severe staphylococcal infections.
在希腊，临床上常将夫西地酸和克林霉素联合用于治疗疑似葡萄球菌感染。
对 2003 年 1 月至 2009 年 12 月期间，在拉里萨大学附属医院的门诊或儿科病房就诊的社区相关性葡萄球菌感染患儿的病历进行了回顾性分析。
309 名患儿（0-14 岁）中，21 名（6.8%）患有侵袭性感染，288 名（93.2%）患有皮肤软组织感染（SSTIs）。35 名患儿年龄均≤30 天。2003-2006 年，由社区相关性耐甲氧西林金黄色葡萄球菌（CA-MRSA）分离株引起的葡萄球菌感染比例为 51.5%（69/134），2007-2009 年则增至 63.4%（111/175）（P = 0.037）。在 CA-MRSA 分离株中，88.9%对夫西地酸耐药，77.6%对四环素耐药，21.1%对克林霉素耐药。2003 年至 2009 年，CA-MRSA 分离株对克林霉素的耐药率从 0%（2003 年）增加至 31.2%（2009 年）（P = 0.011）。7 年间，耐多药 CA-MRSA 分离株的数量有所增加（P = 0.004）。对 140 株 MRSA 分离株进行的 131 株（93.6%）Panton-Valentine 白细胞毒素检测呈阳性。72 株 CA-MRSA 分离株的多位点序列分型显示，它们属于 ST80（n = 61）、ST30（n = 6）、ST377（n = 3）、ST22（n = 1）和 ST152（n = 1）。ST80（n = 58）、ST30（n = 1）和 ST22（n = 1）分离株对夫西地酸耐药。
在高比例多重耐药 CA-MRSA 感染率地区，主要流行的是欧洲 ST80 克隆，因此，对于疑似严重葡萄球菌感染的患者，在经验性治疗时，应谨慎使用夫西地酸和克林霉素。
